Senior Risk Adjustment Coder & Education Lead

ADP, Inc.; Town of Florida (NY); Remote; USD 95,000 - 135,000; Full time

Job summary

ADP, Inc. in New York is seeking a Senior Risk Adjustment Coder to drive accurate, compliant risk adjustment coding through retrospective audits, chart reviews, and provider education.

The role partners with physicians, practice staff, and operations to improve RAF accuracy, support onboarding, and sustain ongoing education on documentation integrity and coding guidelines across Medicare Advantage and related programs.

Qualifications

• Minimum 4+ years of risk adjustment coding and/or auditing experience.
• CRC, CPC, or CDEO certification required; multiple certifications preferred.
• Experience in Medicare Advantage or value-based care is strongly preferred.

Responsibilities

• Conduct retrospective documentation audits to validate diagnosis capture and CMS guidelines.
• Perform two-sided chart reviews to identify documentation gaps and recapture opportunities.
• Evaluate records for complete, compliant support of submitted diagnoses.
• Develop and deliver physician education on documentation integrity and RAF accuracy.
• Support new PCP onboarding with education and training on risk adjustment documentation.
• Provide ongoing education to PCPs and practice teams on audit trends and regulatory updates.
• Track audit outcomes and report findings to improve coding accuracy and program performance.
• Serve as SME on PBACO risk adjustment tools including pre-visit and concurrent capabilities.
• Partner with the PES department to drive improvement in risk adjustment.

Skills

HCC methodology

ICD-10-CM coding

CMS risk adjustment

Documentation standards

Audit skills

Communication

EHR proficiency

Education

HCC certifications (CRC/CPC/CDEO)

Bachelor’s degree preferred

Tools

PBACO risk adjustment tools

EHR systems

Excel

PowerPoint

Job description

ADP, Inc. in New York is seeking a Senior Risk Adjustment Coder to drive accurate, compliant risk adjustment coding through retrospective audits, chart reviews, and provider education.

The role partners with physicians, practice staff, and operations to improve RAF accuracy, support onboarding, and sustain ongoing education on documentation integrity and coding guidelines across Medicare Advantage and related programs.